Kneecap Pain: Symptoms, Causes, and Therapy

Kneecap pain occurs mainly in active people and people who kneel a lot due to work. The symptoms are primarily noticeable when walking downhill, for example when hiking, climbing and descending stairs, kneeling, standing or sitting for long periods (theater knees, cinemapain). Pain in the kneecap (lat. Patella) is often the result of excessive strain and goes away by itself after a period of rest.

However, if it is an injury or disease of the kneecap, such as cartilage damage (chondromalacia patellae), knee pain caused by osteoarthritis or a so-called patellar dislocation, in which the kneecap jumps out of its position, therapy is required. Depending on the diagnosis, drug, physical and pain therapies can be used. Physiotherapy exercises are also often prescribed. Surgical interventions are usually only carried out if the conservative measures are unsuccessful.


  • Pain in the kneecap
  • Symptoms of kneecap pain
  • Symptoms
  • Causes of pain in the kneecap
  • Patellar lateralization
  • Dislocation of the patella
  • Patellar tip syndrome
  • Kneecap pain from Plica Syndrome
  • Chondromalacia patellae
  • When is medical assistance necessary?
  • Naturopathy Therapies

Symptoms of kneecap pain

Retropatellar cartilage damage, patellar dislocation (jumping out / dislocation of the kneecap), patellar lateralization (lateral displacement of the kneecap), patella crepitations (noticeable rubbing behind the kneecap), patellar arthrosis, chondropathia patellae and others.


Those affected are particularly affected by pain in the kneecap when walking downhill and climbing stairs. Many people also experience pain when kneeling or standing for long periods. So-called “cinemapain” or “theater knee” are pain that occurs on the kneecap after long periods of sitting.

The pain can appear on, beside, and behind the kneecap. Similarly, pain below the kneecap possible. Often the complaints occur at the transition to bones, ligaments and cartilage, which those affected perceive as punctual and stinging.

Causes of pain in the kneecap

The kneecap is a flat, disc-shaped, triangular free-running bone when viewed from the front, which lies in front of the knee joint. It protects the knee joint, reduces friction in the four-headed thigh muscle and increases its leverage. The kneecap is connected to the knee joint capsule by tendons, ligaments and muscles and slides up and down in a groove on the thighbone (femur) when the knee joint is moved.

Due to the high forces in the kneecap joint and the lack of stable bony joint guidance, muscular disorders and malformations of the plain bearing can lead to severely restrictive complaints, which those affected find extremely painful. Another cause can be impact accidents and twisting of the knee joint.

The diagnosis of kneecap pain is not always easy and often requires examinations that go beyond the knee joint. The function of the kneecap depends, among other things, on the functions of the thigh extensor, the overall statics of the pelvis and legs, the vascular and nerve supply from the lower back and the metabolism in general.

A holistic view of the patient’s complaints is therefore particularly important. As possible should, for example, chronic circulatory disorders , back pain , low back pain or back pain are considered in the diagnosis and treatment of kneecap problems. This is the case in osteopathy , for example .

Patellar lateralization

In the case of so-called patellar lateralization, the kneecap tends to shift to the side due to a slight instability and thus get “off track”. A muscle imbalance (imbalance) is often the cause of the tendency to shift, in which the outer muscles predominate and the kneecap is therefore increasingly pressed to the sides.

Patellar lateralization can lead to permanent instability and wear and tear of the articular cartilage (patellar arthrosis, chondropathia patellae) and cause severe pain and audible rubbing noises (crepitations).

In order to prevent permanent damage and signs of wear and tear on the cartilage, targeted muscle training and stretching of the shortened muscle groups are used to counter the tendency of the kneecap to shift sideways. If purely conservative therapy is not sufficient, arthroscopic operations can be performed to stabilize the movements of the kneecap.

Dislocation of the patella

A dislocation of the kneecap is called a patellar dislocation. Colloquially it is also said that “the kneecap has jumped out ”. The petallal dislocation usually occurs the first time as a result of a fall or impact and is found to be very painful. A bruise in the joint and an injury to the internal extensor system (medial retinaculum) can be associated with the dislocation of the kneecap. The cause can also be a flat, flat malform of the plain bearing due to the nature of the problem or weak ligaments and muscles.

Often children and adolescents are already affected by a patellar dislocation. In order to avoid consequential damage, treatment should be carried out as early as possible. Because, similar to a shoulder dislocation, the risk of this occurring again and again increases with every further dislocation of the kneecap. As with patellar lateralization, there is no causal conservative therapy, but appropriate muscle training and wearing certain orthoses can reduce the risk of renewed patellar dislocations.

If these measures are unsuccessful, a surgical procedure is often necessary in which the capsule is tightened or the patella is restrained so that the path of the kneecap is determined when moving.

Patellar tip syndrome

The so-called patellar tip syndrome refers to a chronic and degenerative overload disease of the kneecap extensor apparatus at the bone-tendon junction of the kneecap tip. The “jumper’s knee” can be very painful, similar to a “tennis elbow”.

Overloading the kneecap tendon leads to hardening and calcium deposits in the tendon attachment to the kneecap. This is caused by repeated strong tensile loads, for example in ball sports and athletics. Those affected complain of pinprick-like, severe pain, which usually occurs in bursts for 15 to 20 minutes.

In order to cure the overload, first and foremost rest and sports leave are required. Often pain relievers and anti-inflammatory drugs are prescribed and special bandages are applied. Treatment with shock waves can also be promising. If the degeneration is already advanced and the pain is chronic, surgical intervention is often necessary in which the patellar tendon is loosened or the regeneration process is stimulated.

Kneecap pain from Plica Syndrome

Kneecap pain can indicate the so-called plica syndrome. These are enlargements and thickenings or folds (plica) of the synovium, which swell due to inflammation and lead to painful entrapment in the joint.

The folds appear above and below the kneecap, laterally and towards the middle of the joint. The consequences are a swollen knee and pain behind the kneecap up to overloading and cartilage damage. Sufferers report feeling like the knee is unstable and giving way or is blocked. Wrinkles can be caused by previous injuries, but also by overuse from sports such as kaftsport or cycling. Likewise, instability of the knee can be the trigger for plica syndrome.

The therapy consists mainly of rest, physiotherapy and pain relieving medication. If the knee is swollen, treatment with ice usually helps: Simply put a few ice cubes in a plastic bag and rub them into the painful area for half a minute. Then warm the area and then repeat the cold application. The fold can also be removed arthroscopically if conservative measures do not provide relief.

Chondromalacia patellae

“Chondromalacia patellae” is a softening and degeneration of the cartilage on the underside of the kneecap. It mainly affects young people and athletes (“runner’s knee”). The pain often occurs on the front of the knee or the kneecap. After long periods of sitting or climbing and descending stairs, the pain worsens and appears to move backwards from the front of the knee.

The causes here include overuse, trauma, particularly high forces acting on the knee cartilage, functional disorders of the thigh muscles, chronic wear and tear and inflammation of the knee joint, knock knees, elevated kneecap and weak ligaments.

The treatment of chondromalacia patellae consists on the one hand of physical therapy and physiotherapy exercises. On the other hand, pain killers are administered. Those affected should take care of their knees and bend only a little. Surgical interventions aim to smooth the frayed cartilage during an arthroscopy or to stimulate the formation of replacement cartilage. Depending on the cause of the cartilage damage, other interventions may also be necessary, for example in the case of a leg axis defect.

When is medical assistance necessary?

Since kneecap pain can have various causes, those affected should always consult a doctor in order to prevent possible subsequent damage. The causes of kneecap pain listed here are only a selection and do not claim to be complete.

Naturopathy Therapies

In naturopathy, acupuncture has long been used as part of traditional Chinese medicine (TCM) in the treatment of knee and kneecap problems. Especially in pain treatment, placing the fine needles along so-called meridians – channels in which the life energy (Qi) flows – leads to the relief of the symptoms. The needles inhibit the processing of pain in the spinal cord, so that the actual pain is reduced. Several acupuncture sessions are often necessary to achieve complete pain relief.

With knee osteoarthritis, leech therapy is promising. During the treatment, the leeches secrete their salvia, which contains many health-promoting substances. For example, the enzymes inhibit blood clotting, widen blood vessels and counteract inflammation and knee joint pain.

So-called cupping can also relieve knee pain . This is also one of the old natural healing methods. The cupping glasses are pulled along the muscle tracts on the oiled skin, which has the effect of accelerating the lymph flow. By cupping the pain pathways are affected, so that the pain after a few sessions are breastfed.

Ayurveda therapy is another natural healing method for knee pain . Ingredients such as lemon, caraway, boxhorn clover and onions are used. Herbal sachets and various warm herbal oils are used in Ayurveda massages to stimulate blood circulation and metabolism. They also loosen hardening and soften the muscles and tendons.

In addition to the massage treatment, Ayurveda therapy also includes a certain diet . Another component of what is probably the oldest surviving health system are yoga exercises, which patients learn to strengthen the knee muscles and stimulate the metabolism. Basically, building muscle is extremely important for most of the symptoms mentioned in order to improve joint control.


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